临床药师参与多囊肾伴感染合并尿毒症患者抗菌药物治疗1例  

Clinical pharmacist participant antimicrobial treatment for a patient suffered from polycystic kidney combined with infection and uremia

作　　者：朱娜 周宬玥 史天陆[2] 张圣雨[2] ZHU Na(The fourth affiliated hospital of Anhui Medical University, Hefei,Anhui,230022,China)

机构地区：[1]安徽医科大学第四附属医院,安徽合肥230032 [2]安徽省立医院

出　　处：《齐齐哈尔医学院学报》2018年第15期1856-1858,共3页Journal of Qiqihar Medical University

基　　金：安徽医科大学校基金项目(2015xkj046; 2015xkj045)

摘　　要：目的通过临床药师参与1例多囊肾伴感染合并尿毒症患者抗菌药物治疗方案的临床实践,探讨药师在合理用药中发挥的作用。方法临床药师参与1例多囊肾伴感染合并尿毒症患者抗感染治疗方案的制订,在比阿培南(0.6g,Q12h,iv.gtt)联合甲硝唑(0.5g,Q12h,iv.gtt)初始治疗方案中,调整比阿培南给药剂量为0.3 g,Q12 h,iv.gtt,建议停用甲硝唑;根据患者病情变化,及时加用万古霉素;针对尿毒症患者,优化万古霉素给药方案,同时重点监护其不良反应。结果临床药师通过分析该患者的病情特点,提出合理的给药建议,临床医生采纳临床药师建议,患者腹痛消失,体温和血象恢复正常,感染得到控制。结论临床药师参与该患者的抗感染治疗及药学监护,协助医师制订用药方案,促进了临床合理用药,提高了药物临床治疗的有效性和安全性。Objective To explore the role of a pharmacist in rational drug use by participating in the antimicrobial therapy in clinical practice of a patient suffered with polycystic kidney combined with infection and uremia.Methods Clinical pharmacists participated in the anti-infective treatment plan formulation for a chronic renal failure patient with polycystic kidney accompanied with infection and uremia. Clinical pharmacists provided suggestion that stop using of metranidazole and adjust the dosage of biapenem(0.3g) in the primary anti-infective plan(biapenem: 0.6g,Q12h,iv.gtt; metranidazole: 0.5g,Q12h,iv.gtt).According to the state of the illness,the clinical phaemacists suggest the doctors to adjust treatment plan by adding with vancomycin.Meanwhile,the appropriate treatment dose of biapenem and vancomycin was carticulated in line with the creatinine clearance of the patient.Finally,the adverse reaction of the nephrotoxicity drug vancomycin was monitored intensively.Results Clinical pharmacists analyzed the characteristics of the patient carefully,put forward rational suggestions seriously,clinicians take advice from clinical pharmacists,the patient's abdominal pain disappeared,body temperature and hemogram returned to normal,and infection was brought under control.Conclusions Clinical pharmacists participate in anti-infective treatment and pharmaceutical care,and assist physicians to develop therapy plan to promote rational drug use in the clinic and improve the effectiveness and safety of clinical treatment.

关 键 词：临床药师 多囊肾 尿毒症 抗菌药物 

分 类 号：R978[医药卫生—药品]